MRI形态学指标评价儿童外侧盘状半月板损伤  

Morphological characteristics for the magnetic resonance imaging assessment of discoid lateral meniscal tears in children

作　　者：孙晓新 周伟[2] 左淑萍[3] 刘昊 宋敬峰 梁春雨 

机构地区：[1]华北理工大学附属医院,河北省唐山市063100 [2]唐山市第三医院,河北省唐山市063100 [3]唐山工人医院,河北省唐山市063100

出　　处：《中国组织工程研究》2017年第7期1104-1109,共6页Chinese Journal of Tissue Engineering Research

基　　金：河北省科技支撑项目(152777139)~~

摘　　要：背景:目前盘状半月板损伤后的形态学变化特征尚不完全清楚,用于评价盘状半月板损伤的形态学指标还有待深入探索。目的:探讨依据形态学指标评价儿童外侧盘状半月板损伤的特异性及敏感性。方法:回顾性分析具有术前完整MRI影像资料并经关节镜手术证实的儿童外侧盘状半月板损伤病例73例(76膝)。由一名经验丰富的影像学副主任医师(医师甲)和一名运动医学科主任医师(医师乙)采用双盲法独立分析所有病例的膝关节MRI图像。采用"游离缘内移征、游离缘肥厚征、肥角征"3个形态学征象作为评价外侧盘状半月板损伤的指标。以膝关节镜检查结果作为诊断金标准,计算上述3个形态学指标评价儿童外侧盘状半月板损伤的敏感性、特异性和诊断准确率,并采用Kappa检验评价2名医师诊断结果的一致性。结果与结论:(1)医师甲依据"游离缘内移征"诊断外侧盘状半月板损伤的敏感性、特异性和准确率为19%,94%和53%;医师乙的相应值为21%,97%和55%;(2)医师甲依据"游离缘肥厚征"诊断外侧盘状半月板损伤的敏感性、特异性和准确率为52%,100%和74%;医师乙的相应值为57%,97%和75%;(3)医师甲依据"肥角征"诊断外侧盘状半月板损伤的敏感性、特异性和准确率为26%,97%和58%;医师乙的相应值为24%,100%和58%;(4)医师甲凭借联合形态学指标诊断外侧盘状半月板损伤的敏感性、特异性和准确率为86%,91%和87%;医师乙的相应值为88%,94%和91%;(5)Kappa评价显示,2名医师采用上述形态学指标评价外侧盘状半月板损伤的一致性好(K值>0.75,P<0.001);(6)结果说明,采用孤立形态学指标评价外侧盘状半月板损伤的特异性较好,但敏感性偏低,而联合应用多种形态学指标可以显著提高诊断的敏感性。形态学指标在儿童外侧盘状半月板损伤的MRI评价中具有一定价值。BACKGROUND： Currently, the morphologic characteristics of the torn discoid lateral meniscus remain unclear, and morphological indexes used to evaluate the discoid lateral meniscus tears still need to be explored. OBJECTIVE： To discuss the specificity and sensitivity of discoid lateral meniscal tears in children using morphological indexes. METHODS： Seventy-three patients（seventy-six knees） with torn discoid lateral meniscus underwent arthroscopy and MRI data of knee examinations were retrospectively reviewed. All MR images were double-blinded, independently, retrospectively analyzed by attending radiologist（doctor A） and sports physician（doctor B）. The following morphological signs of discoid lateral meniscus, such as a internal displaced free edge sign, a hypertrophic free edge sign and a hypertrophied-horn sign, were selected to evaluate the discoid lateral meniscus tears. The likelihood of the discoid lateral meniscus tears was analyzed on basis of arthroscopic findings constituted the gold standard. Sensitivity, specificity and accuracy of MRI diagnosis of the discoid lateral meniscus tears by two physicians were calculated, and the consistency of diagnosis results by two physicians was evaluated using the Kappa statistics. RESULTS AND CONCLUSION：（1） The sensitivity, specificity and accuracy in the diagnosis of discoid lateral meniscus tears by internal displaced free edge sign for doctor A were 19%, 94% and 53%, respectively, and for doctor B were 21%, 97% and 55%.（2） The sensitivity, specificity and accuracy in the diagnosis of discoid lateral meniscus tears by hypertrophic free edge sign for doctor A were 52%, 100% and 74%, respectively, and for doctor B were 57%, 97% and 75%.（3） The sensitivity, specificity and accuracy in the diagnosis of discoid lateral meniscus tears by hypertrophied-horn sign for doctor A were 26%, 97% and 58%, respectively, and for doctor B were 24%, 100% and 58%.（4） The sensitivity, specificity and accuracy in the diagnosis of discoid lateral meni

关 键 词：半月板 胫骨 磁共振成像 组织工程 骨科植入物 关节植入物 外侧盘状半月板 儿童 形态 核磁共振成像 

分 类 号：R318[医药卫生—生物医学工程]